Abstract
Background
De novo malignancy is a worrying complication after kidney transplantation; the type of which may vary due to factors such as the prevalence of viral infection and race. Kaposi sarcoma used to be the most common malignancy among our patients constituting more than one-third of cancers. Nevertheless, we noticed that Kaposi sarcoma has not been observed for a long period. Therefore, we conducted this study to explore such observation.
Methods
Data of all kidney transplant recipients were retrieved and retrospectively analyzed. Their total number was 3126 patients. Their mean age was 28.71 ± 10.97 years and of them, 823 (26.3%) were females. The pattern of Kaposi sarcoma throughout the last decade as well as the preceding three decades was studied. The possible relation between the disappearance of Kaposi sarcoma and three paradigm shifts in our practice, namely the use of mTOR inhibitors, steroid-free regimen and CMV prophylaxis was explored.
Results
Since 2010, no new cases of Kaposi sarcoma have been observed. In addition, patients who have been transplanted after 2006 did not develop such malignancy. Patients who received CMV prophylaxis and/or were maintained on mTOR inhibitor or steroid-free regimens have not developed Kaposi sarcoma. Moreover, CMV prophylaxis had a statistically significant difference when compared to a homogenous group without CMV prophylaxis. However, Kaplan–Meier analysis of patients of the three policies and their counterpart groups showed comparable results.
Conclusion
Kaposi sarcoma, which was previously the most common malignancy, is no longer observed for almost a decade among our kidney transplant recipients. m-TOR inhibitors, steroid-free regimen and CMV prophylaxis policy are possible contributing factors. Nevertheless, only CMV prophylaxis policy had a statistically significant relation to the disappearance of Kaposi sarcoma.
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All data generated or analysed during this study are included in this published article.
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The authors acknowledge the sincere and continous efforts of their colleagues over four decades.
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Ahmed Farouk Donia performed the study design, data analysis and wrote the article. Mohammed Ashraf Fouda, Ayman Fathi Refaie and Moatasem Elsayed Ghoneim were responsible for the integrity of the article and provided important information to the article. Ahmed Farouk Donia, Ayman Fathi Refaie and Bedeir Ali-El-Dein revised and edited the article. The manuscript has been read and approved by all the authors, the requirements for authorship have been met, and each author believes that the manuscript represents honest work.
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Ethical approval was waived by the local Ethics Committee of Urology and Nephrology Center, Mansoura University in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.
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Freely-given, informed consent to participate in the research studies conducted by Urology and Nephrology Center was obtained from the recipients before transplantation. We also declare that no kidneys were donated by prisoners and all the kidney transplant surgeries were conducted under the supervision of the national committee of organ transplantation and Mansoura University.
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Before proceeding to transplantation, patients freely signed an informed consent regarding publication of their data and photographs if needed in the research studies of the Urology and Nephrology Center, Mansoura University, Egypt.
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Donia, A.F., Fouda, M.A., Ghoneim, M.E. et al. The previously common post-kidney transplant Kaposi sarcoma has become non-existent for a decade: an Egyptian experience. J Cancer Res Clin Oncol 147, 1493–1498 (2021). https://doi.org/10.1007/s00432-020-03433-1
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DOI: https://doi.org/10.1007/s00432-020-03433-1